OF ADOLESCENTS and SLEEP)
1. THE PRIMARY CARE PEDIATRIC ARNP IS PER- ANSWER: C. SLEEP DISORDERS AT
FORMING A WELL-CHILD EXAMINATION ON A THIS AGE CAN HAVE LONG-TERM
4-YEAR-OLD CHILD. THE PARENT REPORTS THAT IMPACTS ON LEARNING.
THE CHILD SNORES FREQUENTLY, OFTEN AWAK-
ENS DURING THE NIGHT, AND SEEMS CRANKY
DURING THE DAY. WHAT WILL THE ARNP TELL RATIONALE:
THIS PARENT? SLEEP DISORDERS IN YOUNG CHIL-
DREN CAN HAVE SIGNIFICANT IM-
A. MOST SLEEP DISORDERS ARE BENIGN AND PACTS ON DEVELOPMENT, INCLUD-
WILL BE OUTGROWN. ING LEARNING. EARLY INTERVEN-
B. SLEEP DISORDERS ARE SYMPTOMATIC OF UN- TION IS IMPORTANT TO AVOID NEG-
ATIVE CONSEQUENCES FOR COG-
DERLYING BEHAVIOR PROBLEMS.
NITIVE AND EMOTIONAL DEVELOP-
C. SLEEP DISORDERS AT THIS AGE CAN HAVE MENT.
LONG-TERM IMPACTS ON LEARNING.
D. THE CHILD WILL NEED LONGER DAYTIME
NAPS TO COMPENSATE FOR LOST SLEEP.
2. THE PRIMARY CARE PEDIATRIC ARNP IS PER- CORRECT ANSWER: B. THE PATIENT'S
FORMING A WELL-CHILD ASSESSMENT ON A AGE AT THELARCHE
13-YEAR-OLD FEMALE WHOSE MOTHER ASKS
WHEN HER DAUGHTER'S PERIODS MAY START.
RATIONALE: THE ONSET OF MENAR-
WHICH INFORMATION WILL THE ARNP USE TO
CHE IS CLOSELY RELATED TO THE
HELP ESTIMATE THE ONSET OF PERIODS?
AGE AT WHICH THE ADOLESCENT
EXPERIENCES THELARCHE (BREAST
A. THE AGE OF THE MOTHER'S MENARCHE DEVELOPMENT). THE TIMING OF
THIS DEVELOPMENTAL MILESTONE
B. THE PATIENT'S AGE AT THELARCHE PROVIDES THE BEST ESTIMATE FOR
WHEN MENSTRUATION MAY BEGIN.
, Burn's pediatrics primary care chapter 13 and 16 (DEVELOPMENTALMANAGEMENT
OF ADOLESCENTS and SLEEP)
C. WHEN ADRENARCHE OCCURRED
D. WHETHER LINEAR GROWTH HAS STOPPED
3. THE PRIMARY CARE PEDIATRIC ARNP IS EXAM- CORRECT ANSWER: A. PERFORM
INING A 15-YEAR-OLD FEMALE WHO REPORTS BIOMETRIC SCREENING TO DETER-
HAVING HER FIRST PERIOD AT AGE 13. SHE MINE LEAN BODY MASS
STATES THAT SHE HAS HAD FIVE PERIODS IN
THE LAST YEAR, WITH THE LAST ONE 2 MONTHS RATIONALE:
IRREGULAR PERIODS IN A TEENAGE
PRIOR. SHE PARTICIPATES IN BASKETBALL AT
ATHLETE, PARTICULARLY THOSE IN-
SCHOOL. WHICH ACTION IS CORRECT?
VOLVED IN INTENSE PHYSICAL AC-
TIVITY, CAN BE RELATED TO LOW
A. PERFORM BIOMETRIC SCREENING TO DETER- BODY FAT OR ENERGY DEFICIENCY.
MINE LEAN BODY MASS. BIOMETRIC SCREENING TO ASSESS
BODY COMPOSITION IS IMPORTANT
B. PRESCRIBE ORAL CONTRACEPTIVE PILLS TO IN EVALUATING WHETHER THE IS-
REGULATE HER PERIODS. SUE IS RELATED TO ATHLETIC ACTIV-
C. ITY.
REASSURE HER THAT THIS IS PERFECTLY NOR-
MAL AT HER AGE.
D. REFER HER TO AN ENDOCRINOLOGIST FOR
HORMONAL EVALUATION
4. DURING A WELL-CHILD ASSESSMENT OF A CORRECT ANSWER: D. PARTICIPA-
13-YEAR-OLD MALE, THE PRIMARY CARE PEDI- TION IN SPORTS
ATRIC ARNP NOTES SMALL TESTICLES AND PU-
BIC AND AXILLARY HAIR. TO FURTHER EVALU-
RATIONALE:
ATE THESE FINDINGS, THE ARNP WILL ASK THE
PARTICIPATION IN SPORTS, PARTIC-
PATIENT ABOUT:
ULARLY THOSE THAT INVOLVE IN-
TENSE PHYSICAL ACTIVITY, CAN IM-